Sciatica when you are lying down

My Experience: I am a Dentist who has lived with this problem for 15 years and here are my hard earned tips to help you cope;

My frustration in finding a treatment provider that understands this problem has led me to try and help others by building this site. This is based on my own experience, I am not trained professionally in this field. However it is my experience that treatment providers have very little understanding of how to help us.

I have seen 2 G.P Doctors, 5 Physiotherapists, 2 Chiropractors, 1 Osteopath, 2 Sports Medicine Doctors and 1 Neurologist, 2 Orthopedic Surgeons. I have had about 15 X-rays , one bone scan and one MRI scan. Each person taught me a little, but on their own none was able to isolate the problem.

GP doctors:Had some knowledge but more in line with spinal solutions rather than any other solution

Physiotherapists: some were hopeless and would not give you a positive referral, others were brilliant and when you find one that understands, follow them to the ends of the earth!

Chiropractors: Have enormous 'self belief' which can give you confidence. But only offer short term relief that becomes ever shorter - easy to become addicted to until you realize that the treatments are one dimensional and probably even add to the problem as they seem to' loosen the joints' and create even more instability over time.

Osteopath: Was the first to point to Piriformis (a break through!) , but didn't seem to have a good understanding of Pelvic distortion which can cause Piriformis Syndrome. Was useful, but possibly their focus was too narrow.

Neurologist: Very professional and thorough, reaffirmed piriformis syndrome and actually replicated the symptoms by pressing a point on my left buttock. Said that unless they find something growing on the Sciatic nerve on the scans (couldn't) then nothing could be done.

Orthopedic Surgeon 1: no real understanding of the process, seemed focused on a spinal connection, referred me back to the Physiotherapists.

Orthopedic Surgeon 2: Worked hard on a solution but could not confirm any diagnosis. Put me on to Amitriptyline HCl (see below)

Sports Medicine doctors: One had no real understanding of the process - just took lots of notes and referred me back to a Physiotherapist and Neurologist. The other one was really good and noticed that I was standing like the 'leaning tower of Pisa' which means that one piraformis is stretched and the other was short, hence the priformis syndrome. He has given me an excercise to strengthen the pirformis; lie on my tummy and put affected leg out to the side as far as it will go, and then try to lift it to the ceiling and hold at 90-100% force for 10 secs (x 10) once per day, reduced symptoms quite nicely.

MRI's and X-rays: Showed nothing definitive, very, very expensive.

Causes of Sciatica:

1. Lower Back Distortion

When the joints and the muscles surrounding them fail to function correctly, lower back pain occurs. The sciatic nerve is formed by 5 nerve roots (nerves exiting the spine). If one or more joints are disrupted irritation (pinching) occurs at this level.

2. Piriformis muscle tightness

The most common causes of sciatic pain is the Piriformis Muscle. If you do not have lower back pain, and only have sciatic pain, the reason is your Piriformis muscle.The muscle is tightened from numerous causes – lower back problems, pelvis distortions, over use of the muscles, fatigue and many other factors. The Piriformis muscle gets inflamed and squeezes the sciatic nerve as it travels through it ( 15% of people) or under it.

nocturnal sciatica 2

more details on Piraformis syndrome at bottom of page

3. Pelvic distortion

With any lower back pain, or back pain in general, the pelvis distorts. One side moves forward and the opposite moves backwards. This is a protective mechanism, which helps to take pressure off the joints that are irritated – just look at when you limp or your back is tender, your pelvis height changes so it appears as if one leg is shorter… this is pelvic distortion. As the sciatica nerve runs through the pelvis, if the pelvis distorts it creates nerve tension and the sciatica nerve becomes stretched, creating sciatica pain.

Treatment for Sciatica

please note: My sciatica only comes on at night or if I sit awkwardly, if your Sciatica is different then these are probably not relevant. These are the treatments that have helped me over the years, they are not a recommendation.

1) Stretching for Pain relief/prevention

2) Bed modification

3) Pharmaceuticals

4) Strengthening to remedy Pelvic distortion

5) Surgery

1) Stretching for Pain relief/prevention

Here are a number of stretching exercises to try, all have worked for me for a while ( sometimes up to a year or more), but all have eventually all stop working, so I go onto another one; until that's stops working....

a. Stretches your lower back; in this picture it helps if you hold on to something with your right hand and push down on your knee with you left hand. ( it sometimes 'clicks' your lower back)

lying down sciatica

b. Hamstring stretches; All the muscles on your back, from the back of the head to the heels of your foot are connected (like one big strap). When you stretch any of these, it takes the pressure off the Piriformis. For the bending down one, I find 'bouncing' down to your toes - say a count of thirty 'bounces' is the most effective.

nocturnal sciatica 3 sleeping sciatica nocturnal sciatica


this one I find the most effective note the bent knee; hold for 15 secs you should find it targets the outer hamstring which seems to have a large effect on the piraformis


c. Stretching the sacrum area - good for doing in bed as you don't have to get up! Try rotating your pelvis and tilting your neck at the same time - increases the effectiveness.

sleep sciatica 2

d. Piriformis stretch - really targets the area, bend your neck and rotate your pelvis to increase effectiveness.

night time sciatica night time sciatica 2 sciatica pain 2sleep sciatica

The following are two piriformis stretches that are effective and less likely to harm hip joints and vertebra discs.
http://www.youtube.com/watch?v=0Z6jlBsgak0
http://www.youtube.com/watch?v=2qZ517Rw7ME

e. Tennis ball massage - lie on floor with tennis ball underneath you on dot shown and roll it slowly around so that it massages the Piriformis muscle as shown, spend about 5 minutes a day (watching tv!)

sciatica pain 3

f. Stretching the lumber vertebrae - If you find that on the ground with your legs on a chair helps, then it probably has a spinal component - if so then this excercise can be really good. I find you need to hold onto something - such as elbow on the ground and hand under mattress.

2) Bed Modification

There are certain things that can work ( and in my case controlled it for a couple of years) :

1. I have found a firm bed to be the best, saggy mattresses seem to make it worse.

2. Place a small lumbar roll under your waist to stop your waist sagging when you sleep; usually this only works on one side. Sometimes its best to buy a piece of firm foam and cut it to the size to fit you best. You will know if its the right size; if you wake up in the morning with an achy back on one side then it was probably too thick.

They can be bought as a 10 cm diameter lumber roll like this: (Unless this was soft I would find it too thick, I would cut it in half longways and that would be right for me.)

lying down sciatica 3

Or tie-on versions: (good in theory but I found this too thick for me - probably depends how skinny you are)

sleeping sciatica 2

3. Place a piece of foam under your sheet for a permanent lumbar roll ( strategically placed to work on one/both sides) - I found this worked well for about 2 years.

4. Place a large pillow ( or two pillows) between your knees

night time sciatica 3

5. Place one/two pillows under your knees/calves when sleeping on your side so that your feet/knees are alot higher ( normally do it with affected leg on top)

6. Sleep with your feet on a chair (or foam) works well as a last resort, especially for spinal causes

Experiment with combinations of the above with sleeping on different sides - everyone is different

3). Pharmaceuticals

Pills -Sleeping tablets when things get severe, but you don't want to rely on those things as they have consequences that are all too well known. Anti Inflammatory pills/painkillers I have found pointless as I don't want to have to take them for the rest of my life. Update: I have been put on a low dose of Amytriptyline which in higher doses used to be used as an antidepressant, but at low doses can settle down non specidic nerve irritation - it has greatly improved my symptoms, I am currently looking to wean myself off them on the basis that sometimes if you 'break the cycle' then things settle down.

Creams - I have found one Cream which is excellent, it works by being absorbed into the muscles from the skin and relaxing the Piriformis taking the pressure off the Sciatic nerve that runs though it. you can also use it to experiment with your own case by relaxing specific muscles on their own, such as the hamstring/lower back as they have roles to play.

I use a Herbal cream that works well and can be used safely every day, I just rub it on the buttock of the effected side every night before bed -. Its basic ingredients are peppermint, arnica, calendula and hypericum which are reasonably common so you might be able to get it. The product I use is made in New Zealand called Antiflamme, although I have had succes with 'Deap heat' as well.

NB. Be careful with creams which are absorbed into the Blood stream where they have whole body (systemic) effects, you don't want to use them on a daily basis otherwise you will create other problems. ( e.g. Diclofenac based creams, steroid creams)

I am currently trying Amitriptyline HCl at a dosage about 20% of that used for depressive disorders and have found that nothing happened for 3 weeks then suddenly the symptoms disappeared! Now three months later they are gradually returning, but it is exciting. No one knows why it works but for some reason it does for some conditions. Side effects: I initially got a dry mouth in the morning and felt slightly drowsy when I got up, but they have now disappeared, now the only issue is alcohol intolerance; I have become a very cheap date!

4. Strengthening to remedy Pelvic distortion

The basic problem is that my Pelvis is rotated, this twists and distorts the Piriformis muscle and overloads the hamstrings at the expense of the Glutimus maximus ( at least in my case).

This way is probably the only way you can reverse the changes with any form of permanence, but it requires dedication and targeted exercise to your core muscles in order to twist the pelvis back into position.

On sports doctor had this opinion: He noticed that I was standing like the 'leaning tower of Pisa' which means that one piraformis is stretched and the other was short, hence the priformis syndrome. He has given me an excercise to strengthen the pirformis; lie on my tummy and put affected leg out to the side as far as it will go, and then try to lift it to the ceiling and hold at 90-100% force for 10 secs (x 10) once per day, reduced symptoms quite nicely.

It is not appropriate to go into specifics within this medium as it requires an expert to diagnose and target a specific program based on your own specific needs. You need to find one of those rare Physiotherapists who understand this phenomenon. How to find one? There is no easy solution - trial and error I suppose. The problem with professionals ( including myself) is we exude a confidence which can be born out of a combination of pride and ignorance, so you have to break through that.

 

5. Surgery

I consider this the very last option, and it seems to be be a very blunt instrument indeed. Try everything else first.

Other articles and links of interest:

http://www.eorthopod.com/content/piriformis-syndrome

http://www.eorthopod.com/content/piriformis-muscle-injections

http://www.nervemed.com/piriformis-syndrome/piriformis-syndrome

Here's a New York Times article from 1994 about prirformis syndrome before anyone was talking about it:

http://www.nytimes.com/1994/01/12/us/personal-health-848026.html?pagewanted=all&src=pm


I found your web-site about 18 months ago -- and it was of some help. Many thanks! I have had a very similar track history to yourself with a multiplicity of professionals trying to solve my back problems.
 
The point of this email, is that I went about a year ago to a podiatrist (a bio-mechanical specialist one) in Edinburgh where I live. It turns out that I have a right leg slighty shorter than my left. This has been compounded, as I have got older, with flattening feet, and falling arches. Like you I used to stand with a distinct lean to one side.
 
The treatment for me is simply shoe inserts, with a slightly built up one for my right shoe. The legs have come much more into alignment, and my back problems have hugely improved. I can walk all day again, and also play golf without back discomfort.
 
Just thought I should email you and suggest that you give a top-notch bio-mechanical podiatrist a go. It worked for me.
 
Best regards
Donald Adamson
 
Edinburgh
Scotland

 

I hope this all helps

And best of all Good luck !

Rob Smith

email: wd8500@gmail.com

 

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